Wake_Well Abandonment_20240318 (11)

%YELL ABANDONMENT RECORD FotlnkrnalUsoIUNIX
Tdu> I;.;Ii •,i,k:us4,d fen:itrt:le Jt nuilliple»ells
I.N4c11(nntractnr Infurm.ition: WELL ARANDONMFNT DF.TAII S
Scott Hunt, Jr 7a,Nowthcr of%ells being abandoned: 1
Well Votdlaclol Na:i c 1"Il .ell oo11cf l rwirAh drat►Iurtt u"Aoa his heI P apEn)r r.a .rndrrr•, n;r.t...., ,r !,hNdr .efts ONLI' watr Nx ,wnr
c"�Mwpryr f1..W,A�,tt&L YIM,YN.tr+a,<tNt sNMtllt,rk•trvtN
4561-A
NC 1L.L t l oartclnr Canifa-ainr.!vrtailrr
?h.ApimninlAte%oluiur of hater rentainingis Aell(sr 1wAIJ
SAEDACCO FOR 1 l ER SUPPLY W l?L!S ONLY:
l pe of"dulectaet III":
:.Nell<tm,ftvctinn Ytrmit M:.
ld.V Mil -1l,6-ell perwav 11.e.{,mrol.We.t tjnwxe Ilgaatawr,ell.
-�. lnutunl�t1 tli,inf�tilaM UScd'
3.N ell uK(clunk li 4.41 nw):
N Afur Cuppl+ U ell: 7c.Sealieg Material.Ubed(check all that apply 1:
❑Agncnhunt! DMtrrucirmll lbiic M NCA cealciii(itnut A Rcrltowle Chips of Pellets
❑Cic,nhctmal(Hcatill)z" 'ooling 14tpph t ❑Rmidctaial Walcr SUpph Istu kI ❑ Sated(.enirm Gmut ❑ Dn Clay
131 dinimil.'f'mmnictual DRccidctvial'Valcr Supph t%ltarcd? ❑ Concrete Glout ❑ Drill OdIllip
Dirrie:30011 ❑ Spmlaln Grow ❑Grd%el
\nn-N atcr�,upph Well: (.1 K-rdomic Slum 1-1(filet(explrtm under 7g)
71r1;unuc•ntc: ❑kstiusen
Injection Well: 7f,For each marrri:ll selr•ctt•d ahmr.Hamitic aronunt of n4wriak p.ctl:
❑ALlul er R"haree ❑GnxirAu:gcr Rcim-di.tion Neat Cem.:94lbs1b ,Wtr:5gal. Sand Cem.:lb ,Wtr:gal.
❑tkluder Motum iml Rc%^cn ❑Salnut% Bamcr
❑Aquikr Ttst ❑Skmrmalcr Drauviec Hentonite.:S%lb ,Wtr:gal. type 2 portland Amount:2.5 ga
DExNnntrwallLtilarrlogy ❑SubstdctaeC•outntl
77,Pr-rn idc a brief dauriptutn of the abandonment pritcahre:
C1Gcotherntal(Cfowd l.00pl CiTracer
Tremie grout well from bottom to top; no well tag with info
UGecttherrrtal(H(�un �Cutrlin Rehim) CtQtlh:r(c� tin under';� _
on well was found
4.Date%tU(s)*Mu&nod: 3-28-24 tr
Sa.Well(ucatitrn:
North White Street Landfill24
$.CcttllkaNNt:
F.xt1m th.r►rV:lm Fxilen IDeldapplicaibk5 � / I(li�:��Yi.:•':;1 1,---
1226 N. White St, wake Forest, NC 27587 r +'> i �' ' 3/3/2024
skal Addreu.Cap.and Zip .,_.;:: Qr:'ez::l'tid W'c1t t'outractor tx W¢N lhrrct DOW
Wake _- _ ha•rrtMntrut that Jarrn, l hereby tergh•!hw the wellfsj wax owerel ahancktued ur
C,nslq P'.n c:ILidAkr.nt. `:.,ct+t>t tot runlnixrlrithI5AVC.-ICOY'.I/11k)ar'f- 000lCtl1(itn.dnat'tirin V,ana�arr/s
cmd Mat a tvtpt?/Mix"r(w!1kri befit prmodevi to A w wrll otrtier.
W lAtitude and longitwile in degrerMvmitwtevvennds or decimal degrees:
It 1%cl)frill c:tw kit.long I.,i111)cx17c: 9.Site Magr+'NU ur additional nell details:
You ntm me fire back of this pap to prof I&additiolctl cell site details or►tell
N W+ abatdomnent details. You may also attach atWitiutwl p:igxs it ikx%-,San
(_•ONXTRl1(TION DETAll S OF W'El_IAS)BEING ABANDONED SUBMITTAL iNSTRUCTIOYS
Rite;( Heil u+ratrrtc9nnr ra.iv.f,:11 v of ati7c. F:u xnlhj.tic(Iye.(tutz'I-1kX1-N"a1,t7 tAt tt/t
airUNONLYN-!Ihthrai~a•wstna.mettakvkk%"vw.vvcartathwit,.vrrAsrW 10a. For All Nall,: Submit this form %illim :Ki days of complawn of nell
6a.W'cll ID>i -2 ahardelinical In the fallowing
Dhimin of Watcr Resources,luf4Rna6tu Proccimar Lnit,
6b.Tutrl"ell depth• 20.5 4 fL) 1617 Matz 5crniee Croler,Raleigh,NC 2 7699-16 1 7
111h.Fur lniet(iun W'tc91s: In iRklilion to sending lire funn to fix;ddiess in 10a
xnc. aleo srdmtii otic cap% of this funn uithm :u days of ctnnpletion of Moll
(rc.Rtltelwlr di iuxrer:2 tea.) af:drandonuxnt to the foilonmq
Dhision of Watcr Rewterees,t nderstritnnd Injectiun Contrul Program.
tar! Water letirl heln% Lnrtued.wirfacr_ 5 (ft.) 1636 Hail%cniee("enter,Raleigh.NC 27699-1636
10c.For Water SUyigh A look—gkon Wens: in Wioon to scoi ling ilx form tt.N
(w.Outer casinR length(iflmn%n): unknow' Ift) [lie addresslcsi aa0tc. also submit MSC o4v.% of This font within III d:nS of
:ottvptclwn of%ell abandownew to the .ounh licalth depantnetil of Ilic comity
unknown where:i mndnncd
4. Inner ca�invtabin�tcn;,Kh(if I;ntnln}: If3J
h;',Bergen lcnrtli(if kn,rtln):unknown Al
I rt t 'tt , Nonh('aohtn DeMitutcin of Em Ironrncca arld Natural R%:e. arcc5 -lhh iswn of WaWr k.Soita\s Re%acd lugusi 21+t t